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Comparison of two expert-based assessments of diesel exhaust exposure in a case-control study: programmable decision rules versus expert review of individual jobs.

AbstractOBJECTIVES:
Professional judgment is necessary to assess occupational exposure in population-based case-control studies; however, the assessments lack transparency and are time-consuming to perform. To improve transparency and efficiency, we systematically applied decision rules to questionnaire responses to assess diesel exhaust exposure in the population-based case-control New England Bladder Cancer Study.
METHODS:
2631 participants reported 14 983 jobs; 2749 jobs were administered questionnaires ('modules') with diesel-relevant questions. We applied decision rules to assign exposure metrics based either on the occupational history (OH) responses (OH estimates) or on the module responses (module estimates); we then combined the separate OH and module estimates (OH/module estimates). Each job was also reviewed individually to assign exposure (one-by-one review estimates). We evaluated the agreement between the OH, OH/module and one-by-one review estimates.
RESULTS:
The proportion of exposed jobs was 20-25% for all jobs, depending on approach, and 54-60% for jobs with diesel-relevant modules. The OH/module and one-by-one review estimates had moderately high agreement for all jobs (κ(w)=0.68-0.81) and for jobs with diesel-relevant modules (κ(w)=0.62-0.78) for the probability, intensity and frequency metrics. For exposed subjects, the Spearman correlation statistic was 0.72 between the cumulative OH/module and one-by-one review estimates.
CONCLUSIONS:
The agreement seen here may represent an upper level of agreement because the algorithm and one-by-one review estimates were not fully independent. This study shows that applying decision-based rules can reproduce a one-by-one review, increase transparency and efficiency, and provide a mechanism to replicate exposure decisions in other studies.
AuthorsAnjoeka Pronk, Patricia A Stewart, Joseph B Coble, Hormuzd A Katki, David C Wheeler, Joanne S Colt, Dalsu Baris, Molly Schwenn, Margaret R Karagas, Alison Johnson, Richard Waddell, Castine Verrill, Sai Cherala, Debra T Silverman, Melissa C Friesen
JournalOccupational and environmental medicine (Occup Environ Med) Vol. 69 Issue 10 Pg. 752-8 (Oct 2012) ISSN: 1470-7926 [Electronic] England
PMID22843440 (Publication Type: Comparative Study, Evaluation Study, Journal Article, Research Support, N.I.H., Intramural)
Chemical References
  • Air Pollutants, Occupational
  • Vehicle Emissions
Topics
  • Air Pollutants, Occupational (analysis, toxicity)
  • Algorithms
  • Case-Control Studies
  • Decision Support Techniques
  • Environmental Monitoring (methods, statistics & numerical data)
  • Expert Testimony
  • Humans
  • Models, Theoretical
  • Occupational Exposure (adverse effects, analysis, statistics & numerical data)
  • Retrospective Studies
  • Surveys and Questionnaires
  • Urinary Bladder Neoplasms (chemically induced)
  • Vehicle Emissions (analysis, toxicity)

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